Provider Demographics
NPI:1740609593
Name:OLANREWAJU, OYEWOLE JACOB (MD)
Entity Type:Individual
Prefix:DR
First Name:OYEWOLE
Middle Name:JACOB
Last Name:OLANREWAJU
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:1150 N 18TH ST STE 300
Mailing Address - Street 2:
Mailing Address - City:ABILENE
Mailing Address - State:TX
Mailing Address - Zip Code:79601-2931
Mailing Address - Country:US
Mailing Address - Phone:325-670-6460
Mailing Address - Fax:833-680-9963
Practice Address - Street 1:1150 N 18TH ST STE 300
Practice Address - Street 2:
Practice Address - City:ABILENE
Practice Address - State:TX
Practice Address - Zip Code:79601-2931
Practice Address - Country:US
Practice Address - Phone:325-670-6460
Practice Address - Fax:833-680-9963
Is Sole Proprietor?:No
Enumeration Date:2014-04-09
Last Update Date:2020-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
TXS3729207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program